The premenstrual syndrome and its relationship to accidents

Clinical indications of premenstrual disorders and subsequent risk of injury: a population-based cohort study in Sweden

BACKGROUND

Premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, are suggested to be correlated with suicidal behavior and accidents in cross-sectional and retrospective studies. However, prospective data are still lacking.

METHODS

We performed a population-based cohort study including 1,472,379 Swedish women of reproductive age who were followed from 2001 to 2012. Within the cohort, we also performed a sibling analysis where we compared the rates of injury between full sisters. By linking to the Patient and the Prescribed Drug Registers, we identified 18,628 women with any clinical indications for premenstrual disorders in the cohort (population analysis) and 7674 women in the sibling analysis. Any injury, primarily suicidal behavior (completed suicide and suicide attempt) or accidents (e.g., fall and transportation accidents), was identified through the Patient and Causes of Death Registers as the primary outcome. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of these outcomes among women with premenstrual disorders in both population and sibling analyses using multivariable Cox proportional hazards regression.

RESULTS

During a maximal follow-up of 12 years (mean 9.55 years), we identified 2390 women with premenstrual disorders with any injury; 216 through suicidal behavior and 2191 through accidents. Compared to women without premenstrual disorders, women with premenstrual disorders were at increased risk of any injury (HR 1.37, 95% CI 1.31-1.42), particularly suicidal behavior (HR 2.26, 95% CI 1.97-2.59) and accidents (HR 1.32, 95% CI 1.27-1.38). Such associations somewhat attenuated yet remained significant in the sibling analysis (HRs: 1.31 for any injury, 1.86 for suicidal behavior, and 1.29 for accidents). Additional adjustment for psychiatric comorbidities minimally altered the associations with any injury and accidents in both population and sibling analyses, whereas the association with suicidal behavior was considerably attenuated to non-significance in the sibling analysis. Such risks were particularly strong within 2 years after receiving the diagnosis of premenstrual disorders and were evident among women with premenstrual disorders with and without psychiatric comorbidities.

CONCLUSIONS

Our findings suggest that women with a clinical indication of premenstrual disorders are at increased subsequent risk of injury, particularly accidents within the first 2 years after diagnosis.

Perimenstrual symptoms among Chinese women in an urban area of China

We explored perimenstrual symptoms among 16 Chinese women in an urban area of southeastern China using a retrospective questionnaire, the Menstrual Distress Questionnaire (MDQ), and a prospective daily symptom diary, the Daily Health Diary (DHD), modified for cultural relevance. Mean scores on the DHD were significantly (p < .03) higher during the perimenstrual phase for the symptoms fatigue, increased sensitivity to cold, increased sleeping, abdominal pain/discomfort, painful or tender breasts, and decreased sexual desire. The women who reported higher DHD physical symptom scores prospectively were more likely to recall more severe physical symptoms retrospectively on the MDQ. However, there were remarkable discrepancies between the DHD and MDQ regarding psychoemotional symptoms. By retrospective MDQ, the percentages of women who experienced severe mood swings and irritability ranged from 13% to 25% during the premenstrual and menstrual phases; on the DHDs, however, these emotional symptoms were not statistically associated with the menstrual cycle. The failure of prospective charting to confirm the retrospective reports of cyclic psychoemotional symptoms agrees with findings of studies of U.S. samples. We conclude that perimenstrual distress in Chinese women may be affected by the data collection methods.

Influence of premenstrual syndrome on family, social life, and work performance

Premenstrual syndrome is characterized by mental and physical symptoms that vary with different phases of the menstrual cycle. Symptoms start shortly after ovulation, increase in severity, and reach a maximum during the last five premenstrual days. After the onset of menstrual bleeding, the symptoms rapidly disappear and are usually gone within three to four days. Diagnostic procedures using prospective daily symptom ratings have recently been developed, allowing a more precise diagnosis of the cyclical mood changes and leading to a clearer picture and definition of the condition. Results from community studies show that the severity of the cyclical mood changes varies within a population of women of fertile age, from those having no cyclical mood changes to those severely handicapped by the symptoms for 14 days of the month. The severity assessment of subjective symptoms is difficult since severity is difficult to compare among individuals. In this article the authors review the different approaches to estimating severity of premenstrual syndrome and compare the different approaches with approaches used for other conditions with subjective symptoms. Two possible approaches are discussed in detail. One measures symptoms by counting the number of days with and without symptoms. The other estimates how much the symptoms affect patients' family life, social life, and work performance. Differences between retrospective and prospective assessments are also discussed.